Remote Medical Claims Specialist

Old Republic Commercial Risk; Fresno (CA); On-site; USD 58,000 - 73,000; Full time

Job summary

Old Republic Commercial Risk is seeking a remote claims professional to manage medical-only and limited lost time claims, and to oversee permanent total claims with a focus on minimizing losses while providing excellent customer service. The role requires 1+ year of workers' compensation claims handling, knowledge of medical terminology, and strong organizational and communication skills.

Responsibilities include prompt file setup, payments, diary management, and ensuring compliance with

Qualifications

• High school diploma or equivalent required.
• 1+ years of Workers Compensation claims handling experience preferred.
• Proficiency with medical terminology and documentation.

Responsibilities

• Contact accounts on First Notices of Loss to obtain missing information for file setup.
• Process payments, answer phone calls, and authorize medical treatments for Medical Only claims.
• Maintain timely diary notes and complete contacts within 24 hours of assignment.
• Assess treatment appropriateness and relation to injury.
• Directs treatment to network physicians as appropriate.
• Refer subrogation or permanency claims to Supervisor.
• Ensure compliance with jurisdictional requirements and licensing.
• Monitor benefits on Permanent Total or Death cases and notice changes in life/work status.

Skills

Strong organizational skills

Excellent verbal and written沟通 skills

Education

High school diploma or equivalent

Tools

MS Excel

MS Word

Job description

Old Republic Commercial Risk is seeking a remote claims professional to manage medical-only and limited lost time claims, and to oversee permanent total claims with a focus on minimizing losses while providing excellent customer service. The role requires 1+ year of workers' compensation claims handling, knowledge of medical terminology, and strong organizational and communication skills.

Responsibilities include prompt file setup, payments, diary management, and ensuring compliance with